Symptomology/Clinical Manifestations of AUB

Discuss and described the pathophysiology and symptomology/clinical manifestations of AUB.
. Discuss three differential diagnoses for AUB with 1CD 10 numbers for each.
Discuss patient education.
* Develop the management plan (pharmacological and nonpharmacological).

Abnormal Uterine Bleeding (AUB)

Pathophysiology

Abnormal Uterine Bleeding (AUB) is characterized by irregularities in the menstrual cycle, including changes in the frequency, duration, and amount of bleeding. The pathophysiology of AUB can be multifactorial and is often categorized into structural and non-structural causes.

1. Structural Causes (PALM)
   • Polyps: Benign growths on the lining of the uterus or cervix.
   • Adenomyosis: Endometrial tissue grows into the muscular wall of the uterus.
   • Leiomyomas (Fibroids): Non-cancerous growths in the uterus.
   • Malignancy and Hyperplasia: Abnormal tissue growth which may lead to cancer.
2. Non-Structural Causes (COEIN)
   • Coagulopathy: Bleeding disorders affecting blood clotting.
   • Ovulatory Dysfunction: Irregular ovulation patterns leading to abnormal bleeding.
   • Endometrial: Issues with the endometrial lining not related to structural abnormalities.
   • Iatrogenic: Caused by medical interventions such as medications.
   • Not yet classified: Causes that do not fit into the other categories.

Symptomatology/Clinical Manifestations

• Menorrhagia: Heavy menstrual bleeding.
• Metrorrhagia: Bleeding between periods.
• Polymenorrhea: Frequent periods.
• Oligomenorrhea: Infrequent periods.
• Postmenopausal Bleeding: Bleeding occurring after menopause.
• Spotting: Light bleeding or spotting between periods.
• Dysmenorrhea: Painful menstruation.

Differential Diagnoses for AUB

1. Polycystic Ovary Syndrome (PCOS)
   • ICD-10 Code: E28.2
   • Characterized by irregular menstrual cycles, androgen excess, and polycystic ovaries.
2. Endometrial Hyperplasia
   • ICD-10 Code: N85.00
   • Thickening of the endometrium which can lead to abnormal bleeding.
3. Hypothyroidism
   • ICD-10 Code: E03.9
   • An underactive thyroid gland that can affect menstrual regularity.

Patient Education

• Understanding AUB: Educate the patient about what AUB is and the potential causes.
• Monitoring Symptoms: Encourage tracking menstrual cycles, noting changes in frequency, duration, and volume of bleeding.
• When to Seek Help: Advise when to seek medical attention, such as heavy bleeding, severe pain, or bleeding after menopause.
• Lifestyle Modifications: Discuss the importance of maintaining a healthy weight, regular exercise, and a balanced diet.
• Medication Adherence: If medications are prescribed, explain the importance of adherence and potential side effects.

Management Plan

Pharmacological

1. Hormonal Therapy
   • Combined Oral Contraceptives: Regulate menstrual cycles and reduce bleeding.
   • Progestin Therapy: Administered orally, intramuscularly, or through an intrauterine device (IUD).
   • GnRH Agonists: Used for severe cases to reduce bleeding and shrink fibroids.
2. Non-Hormonal Therapy
   • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Reduce menstrual blood loss and pain.
   • Tranexamic Acid: An antifibrinolytic agent used to reduce bleeding.

Non-Pharmacological

1. Surgical Interventions
   • Endometrial Ablation: Removal or destruction of the endometrial lining.
   • Myomectomy: Surgical removal of fibroids.
   • Hysterectomy: Removal of the uterus, considered in severe or refractory cases.
2. Lifestyle and Home Remedies
   • Diet and Exercise: Maintain a healthy weight to help regulate menstrual cycles.
   • Stress Management: Techniques such as yoga, meditation, and counseling.
   • Iron Supplements: To manage or prevent anemia due to heavy bleeding.
3. Regular Monitoring
   • Follow-Up Appointments: Regular check-ups to monitor treatment effectiveness and adjust as needed.
   • Ultrasounds and Biopsies: As necessary to evaluate the underlying cause and monitor any changes.